Desperately Seeking Health Insurance

subject to debate
by Katha Pollitt

As crises go, medical insurance is not a very sexy one.
It’s not that no one talks about the 43.6 million
uninsured, skyrocketing drug costs, emergency rooms
crammed with patients in search of routine care or the
18,000 Americans who, according to the Institute of
Medicine, die each year for lack of care. Every
politician has a stump speech and a plan—usually a
rather complicated one. (Insert your Kerry joke here if
you must, but give the man credit—at least he’ll cover
most people.) The simple solution would be a
single-payer system like Canada’s, a mantra the left
has been humming for decades, but where’s the big,
irate, energetic movement for it? Health coverage
doesn’t seem to bring out the fire-breathers, like, oh,
gay marriage or "partial-birth" abortion or whether
"under God" belongs in the Pledge of Allegiance.

Why is that? Maybe we’ve been living this way so long
that we’ve just accepted it, like the housing crisis.
Maybe the kinds of people who are uninsured are the
sort voters are all too used to ignoring. Maybe people
don’t want to pay for universal coverage (even though
they tell pollsters they’re willing). And maybe the
political classes, who have good coverage and money and
tend to live in places with lots of specialists and
state-of-the-art hospitals, fear they’d have to stand
in line under a Canadian-style system, as the New York
Times is always warning them they would.

While wonks debate, the crisis deepens. Dr. Michele
Barry, who directs tropical medicine at Yale Medical
School, sent me her notes on three patients she saw
within a single week recently at Yale-New Haven
Hospital:

Mr. N. An Italian-American man in his early 50s who
moved from Florida to New Haven to let his wife die up
near her family in Maine. He went 250,000 dollars in
debt trying to self-pay for care for his wife, who was
diagnosed with cervical cancer over a year ago. He was
admitted to my service with hyperkalemia (high
potassium) due to using expensive medicines he could
get for free from pharmaceutical donations—these were
inappropriate for his kidney problems, which were
caused by diabetes. He could not even afford the
long-acting insulin we wanted to give him. His reply to
my telling him he might die if we didn’t treat his
potassium was: "Doc, maybe that’s for the better."

Mr. M. A 38-year-old auto mechanic who was admitted in
narcotic withdrawal. A year ago, he was the victim of a
freak accident when a clutch released and a car rolled
back into him. He developed back pain which
subsequently caused him to seek several neurosurgical
opinions, but nothing was done because he couldn’t
afford follow-up appointments. He became addicted to
the OxyContin the doctors prescribed. Unemployed,
disabled and out of money due to medical costs of
imaging and doctors, he lost his home and was forced to
move to a motel and file for bankruptcy. He came into
the hospital when he could not afford his motel room or
any more narcotics and thus started to withdraw.

Ms. W. A 40-year-old black woman from North Carolina
who came into my service with hypertensive emergency
(escalating blood pressure) and heart failure. She had
stopped taking any blood pressure medicines in order to
save for her husband’s kidney transplant. Due to her
prolonged non-treatment, she developed irreversible
heart damage.

As these tragic stories show, health insurance is about
more than treating an immediate illness. Lack of
insurance can precipitate an avalanche of trouble: job
loss, debt, bankruptcy, more illness, inappropriate
charity treatment that worsens the original problem,
prescription drug addiction, homelessness. The crisis
doesn’t even have to be yours: Mr. N.’s diabetes and
Ms. W.’s hypertension—common, manageable
conditions—became life-threatening because they
skimped on their own medicine to help a spouse with an
even bigger problem. In the case of Mr. N.’s wife, her
fatal illness was itself possibly related to lack of
preventive care because she didn’t have health
insurance: Cervical cancer is usually curable if caught
early on by regular Pap smears.

Critics complain about the cost of universal coverage,
but if you think of those 43.6 million uninsured as
embedded in families, you have to count the privations
endured by everyone in them as part of the true cost of
the status quo. More money for a parent’s doctor means
less for the children’s dentist—or summer camp, or
college fund. Untreated or inadequately treated illness
means stress and anxiety for the whole family. When a
patient goes bankrupt, like Mr. M.—and healthcare
costs are involved in 50 percent of bankruptcies, which
have risen 400 percent in the past twenty-five
years—the whole family suffers. Conservatives are
always worrying about divorce—what about divorce as
triggered by the financial and emotional stresses of
uninsured illness? Maybe universal coverage could be
sold as a family value.

Dr. Barry, who moves mountains for her patients, is
doing all that one doctor can do. She was able to
arrange donated drugs for Ms. W. and Mr. N., as a
temporary stopgap. But what will happen to them down
the road? As for Mr. M., she writes, "We gave him a
long-acting morphine compound—not OxyContin!—for his
pain and are trying to find him a surgeon who will
accept state insurance. Not one orthopedic in our area
does this. He was last seen living in a shelter in
town."

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